Kandarpkumar K Patel, Siravich Suvithayasiri, Yanting Liu, Jin-Sung Kim
{"title":"Transdural rootlet herniation- An exceptional complication of full endoscopic lumbar discectomy: case reports and review of literature.","authors":"Kandarpkumar K Patel, Siravich Suvithayasiri, Yanting Liu, Jin-Sung Kim","doi":"10.1007/s00586-025-09137-9","DOIUrl":"https://doi.org/10.1007/s00586-025-09137-9","url":null,"abstract":"<p><strong>Introduction: </strong>Endoscopic lumbar spine surgery has been regarded as a safe and minimally invasive procedure over the last decades. The incidence of dural tears in endoscopic spine surgery has been around 1.1%. Transdural nerve root herniation is a rare but severe complication if not treated early. We reviewed the literature related to our cases. A classification is proposed by the authors to categorize the cases into 4 types.</p><p><strong>Case description: </strong>We present 5 cases of transdural nerve root herniations in endoscopic lumbar spine surgery. The five cases have been classified into four different types by their time of detection, neurological status, and associated complications. According to anatomical location, 3 cases were ventral, one was lateral, and one was dorsal. One case was detected intraoperatively, while four were detected after the patient showed symptoms postoperatively. 4 cases were operated with a transforaminal endoscopic approach, and 1 case was operated with an interlaminar full endoscopic approach. One patient presented late with a neurological deficit, whereas one patient presented with pseudomeningoceole and infection. All root herniation cases were treated with an open microscopic repair. All five patients improved symptomatically postoperatively with no further complications. The classification can help categorize the nerve root herniation type in correlation with clinical outcomes. These five cases are described in detail in the manuscript.</p><p><strong>Conclusion: </strong>In our studies, we have given a classification for transdural nerve root herniation in endoscopic lumbar spine surgery. Clinical judgment and radiological evaluation in the postoperative period are vital in cases of unrecognized nerve root herniation. Early detection, repositioning of the nerve root inside the dura, and repair of the dura tear are the treatment of choice for better outcomes.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144648970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Does the posterior-only approach provide adequate treatment for cervical spine metastases with severe vertebral body compromise?","authors":"Zhehuang Li, Panhong Zhang, Xiaoying Niu, Po Li, Xu Liu, Weitao Yao, Jing Wen, Suxia Luo, Peng Zhang","doi":"10.1007/s00586-025-09127-x","DOIUrl":"https://doi.org/10.1007/s00586-025-09127-x","url":null,"abstract":"<p><strong>Purpose: </strong>To assess posterior-only surgery for cervical spine metastases with severe vertebral compromise, characterized by severe compression fracture, ventral epidural compression, and extensive osteolytic destruction.</p><p><strong>Methods: </strong>We retrospectively analyzed 31 patients with C1-T1 metastases meeting severe compromise criteria: compression fracture with > 50% height collapse or local kyphosis, severe ventral compression with the epidural spinal cord compression scale > 1b, or extensive osteolytic destruction involving > 50% of the vertebral body. Comprehensive clinical assessments included pain severity (Numeric Rating Scale, NRS), neurological function (Frankel grading system), and performance status (Eastern Cooperative Oncology Group, ECOG). Radiographic evaluation focused on cervical sagittal alignment parameters. Survival analysis was performed using Kaplan-Meier methodology.</p><p><strong>Results: </strong>Significant improvements were observed in pain (NRS: 6.1 ± 2.0 to 2.3 ± 1.2, P < 0.001), neurological function (90% of deficit patients improved ≥ 1 Frankel grade), and performance status (ECOG:3.1 ± 0.8 to 1.7 ± 0.9, P < 0.001). Cervical sagittal alignment was significantly restored in compression fracture cases. The surgical approach exhibited favorable stability with no instances of instrumentation failure during follow-up. Survival analysis indicated median overall survival of 11.0 months, with survival rates of 87.1%, 67.7%, and 48.4% at 3, 6, and 12 months postoperatively, respectively.</p><p><strong>Conclusion: </strong>The posterior-only surgical approach can effectively addresses severe vertebral body compromise in cervical metastases, providing durable pain relief, neurological preservation, and stability with acceptable morbidity. Future studies should develop evidence-based algorithms integrating tumor characteristics and patient factors to guide surgical decisions in metastatic cervical spine disease.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144642196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bardia Hajikarimloo, Salem M Tos, Ibrahim Mohammadzadeh, Mohammad Amin Habibi
{"title":"Answer to the letter to the editor of T. Tu concerning \"Machine learning-based models for outcome prediction in skull base and spinal chordomas: a systematic review and meta-analysis\" by B. Hajikarimloo, et al. (Eur spine J [2025]: doi: 10.1007/s00586-025-09053-y).","authors":"Bardia Hajikarimloo, Salem M Tos, Ibrahim Mohammadzadeh, Mohammad Amin Habibi","doi":"10.1007/s00586-025-09118-y","DOIUrl":"https://doi.org/10.1007/s00586-025-09118-y","url":null,"abstract":"","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144642195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Answer to the letter to the editor of K. Zhou et al. concerning \"early functional training is not superior to routine rehabilitation in improving walking distance and multifidus atrophy after lumbar fusion: a randomized controlled trial with 6-month follow-up\" by Lu H, et al. (Eur spine J [2025]: doi: 10.1007/s00586-025-08771-7).","authors":"Hongyuan Lu, Wei Feng","doi":"10.1007/s00586-025-09133-z","DOIUrl":"https://doi.org/10.1007/s00586-025-09133-z","url":null,"abstract":"","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144642194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Letter to the editor concerning \"The association between postoperative physical therapy and opioid prescription after posterior lumbar interbody fusion: a retrospective cohort study of united States academic health centers\" by Baumann AN, et al. (Eur spine J [2025]: doi: 10.1007/s00586-025-08824-x).","authors":"Linjie Dai, Kuangyang Yang","doi":"10.1007/s00586-025-09138-8","DOIUrl":"https://doi.org/10.1007/s00586-025-09138-8","url":null,"abstract":"","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144642170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The effect of pelvic incidence on age-related changes in spinopelvic sagittal alignment in older individuals: a longitudinal study for 10 years.","authors":"Yu Yamato, Tomohiko Hasegawa, Go Yoshida, Tomohiro Banno, Hideyuki Arima, Shin Oe, Koichiro Ide, Tomohiro Yamada, Yusuke Murakami, Yukihiro Matsuyama","doi":"10.1007/s00586-025-09136-w","DOIUrl":"https://doi.org/10.1007/s00586-025-09136-w","url":null,"abstract":"<p><strong>Purpose: </strong>Spinopelvic sagittal alignment is a critical determinant of the quality of life and clinical outcomes in older adults. Although pelvic incidence (PI) is a well-established morphological parameter influencing spinopelvic alignment, its role in age-related alignment changes and compensatory mechanisms remains incompletely understood. This study aimed to investigate the influence of PI magnitude on 10-year changes in spinopelvic sagittal alignment and compensatory adaptations in a community-dwelling older population.</p><p><strong>Methods: </strong>We analyzed 135 adults (mean age: 68.5 years in 2012) who underwent whole-spine lateral radiography between 2012 and 2022. Participants were classified into three groups based on their 2012 PI values: Low PI, Mid PI, and High PI. Radiographic parameters, including thoracic kyphosis (TK), upper and lower lumbar lordosis, sacral slope, pelvic tilt (PT), and sagittal vertical axis (SVA), were compared longitudinally. Changes in alignment were assessed, and compensatory mechanisms were evaluated in relation to PI magnitude.</p><p><strong>Results: </strong>Regardless of PI magnitude, participants demonstrated pelvic retroversion and kyphotic changes in the upper lumbar spine over the 10-year period. However, compensatory strategies differed among the groups. Individuals with low PI exhibited increased TK and compensatory hyperlordosis in the lower lumbar region. Conversely, those with high PI showed decreased TK and progressive kyphotic changes in the lower lumbar spine. Notably, no significant group differences were observed in SVA or PT progression.</p><p><strong>Conclusion: </strong>PI magnitude significantly influences compensatory mechanisms associated with age-related deterioration of spinopelvic alignment. These findings highlight the need for individualized evaluation and management strategies based on PI morphology in aging populations.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144642171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Letter to the editor concerning \"relationship between posterior paraspinal muscle fat infiltration and early conversion to lumbar spinal fusion following decompression surgery\" by Chiapparelli E, et al. (Eur spine J [2025]: doi: 10.1007/s00586-025-09030-5).","authors":"Jiajun Deng, Yongchun Xiao","doi":"10.1007/s00586-025-09148-6","DOIUrl":"https://doi.org/10.1007/s00586-025-09148-6","url":null,"abstract":"","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Suzanne McIlroy, Yee Mah, Vassilios Tahtis, Abigail Beddard, Lindsay Bearne, John Weinman, Sam Norton
{"title":"Minimal clinically important difference of the 6-Minute walk test and daily step count at 3 months following surgery for lumbar spinal stenosis.","authors":"Suzanne McIlroy, Yee Mah, Vassilios Tahtis, Abigail Beddard, Lindsay Bearne, John Weinman, Sam Norton","doi":"10.1007/s00586-025-09085-4","DOIUrl":"https://doi.org/10.1007/s00586-025-09085-4","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to estimate the minimal clinically important difference (MCID) in two objective measures of walking: 6-minute walk distance (6MWD) and mean daily step count in patients with lumbar spinal stenosis, three months post-surgery. Both anchor-based and distribution-based approaches were used to support result robustness and comparability.</p><p><strong>Methods: </strong>97 patients (mean age 70 ± 8.3 years; 50 female) were recruited from three UK hospitals. 6MWD (metres) and mean daily step count (measured over 7 days with an accelerometer), and self-rated clinical questionnaires were assessed pre- and 12-weeks post-surgery. The anchor-based method used the Oswestry Disability Index (ODI) and the satisfaction subscale of the Zurich Claudication Questionnaire. Receiver-operating characteristic (ROC) curve analysis was used to determine the optimal cutoff points for MCIDs for changes in the 6MWD and step count. The distribution-based method used 0.3 SD of the change scores.</p><p><strong>Results: </strong>Anchor-based MCIDs for the 6MWD were 26 m (ODI) and 35 m (walking satisfaction). The step count MCID could not be determined using the ODI but was 680 steps when anchored to satisfaction. The distribution-based method estimated MCIDs of 34 m for the 6MWD and 750 steps for step count.</p><p><strong>Conclusion: </strong>Even modest improvements in walking capacity and daily step count may be meaningful to patients recovering from LSS surgery. Further research is needed to validate the MCID for daily step count however, the identified MCIDs for the 6MWD (26-35 m) and daily step count (680-750 steps) provide practical thresholds for assessing meaningful change and can be used to inform goal setting within rehabilitation.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Risk factors for new vertebral fracture after percutaneous vertebroplasty or kyphoplasty for osteoporotic vertebral compression fractures (OVCFs): an updated systematic review and meta-analysis.","authors":"Yan-Shiang Lian, Lei-Po Chen, Ji-Ying Chen","doi":"10.1007/s00586-025-09082-7","DOIUrl":"https://doi.org/10.1007/s00586-025-09082-7","url":null,"abstract":"<p><strong>Purpose: </strong>Osteoporotic vertebral compression fractures (OVCFs) are common in older persons, and percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) are effective minimally invasive treatments. This systematic review and meta-analysis aim to update knowledge on risk factors associated with NVCF after these procedures.</p><p><strong>Methods: </strong>PubMed, EMBASE, and the Cochrane Library were searched to December 2023 for studies evaluating risk factors for NVCF after PVP and PKP, using the following keywords: \"osteoporotic vertebral compression fractures,\" \"percutaneous vertebral augmentation,\" \"vertebroplasty\", \"kyphoplasty,\" \"new vertebral fracture,\" and \"risk factor\". Eligible studies included randomized controlled trials (RCTs), prospective and retrospective studies, and case-control studies. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to derive summary effects. Heterogeneity among the studies was assessed using the I<sup>2</sup> statistic.</p><p><strong>Results: </strong>Fifteen studies including a total of 6,546 patients were analyzed. Significant risk factors for new vertebral fractures (NVCF) following PVP and PKP were older age (adjusted OR [aOR] = 1.08, 95% CI: 1.01-1.15), female sex (aOR = 2.11, 95% CI: 1.60-2.79), a higher number of treated vertebrae (aOR = 2.27, 95% CI: 1.18-4.35), and cement leakage (aOR = 3.43, 95% CI: 2.17-5.41). No statistical significances on the associations between bone mineral density (BMD), body mass index (BMI) with NVCF were observed.</p><p><strong>Conclusion: </strong>Significant risk factors for NVCF after PVP and PKP include older age, female sex, higher number of treated vertebrae, and cement leakage. The findings highlight the importance of careful patient selection to minimize the risk of NVCF.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144625779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}